The Sinister Face of Tuberculosis

Case Report

Austin J Clin Case Rep. 2014;1(3): 1013.

The Sinister Face of Tuberculosis

Haque S, Kim H, Cheruvu S and Olowokure OO*

Department of Internal Medicine and Hematology Oncology, University of Cincinnati, USA

*Corresponding author: Olowokure OO, Department of Internal Medicine and Hematology Oncology, University of Cincinnati, 234 Goodman Street, Cincinnati, OH 45219, USA

Received: May 30, 2014; Accepted: June 12, 2014; Published: June 14, 2014


Tuberculosis (TB) still remains a deadly scourge in many developing countries and is re-emerging globally with a vengeance. In India, clinicians are encountering tuberculosis with varied manifestations, even in immunocompetent individuals. Adolescents are unique that they may manifest with primary or post-primary TB depending on their immune response. The simultaneous occurrence of primary and post primary TB in an immunocompetent adolescent is a rare presentation, as is highlighted in this case.

Keywords: Tuberculosis; Primary; Post-primary

Case Presentation

A 15-year old girl was admitted to our medical unit with 2-month history of high grade fever, cough with expectoration, anorexia and marked weight loss. There was no significant illness in the past and family history was not contributory. On examination she was cachexic and findings of consolidation in left infraclavicular and mammary region, with no evidence of peripheral lymphadenopathy or hepatosplenomegaly. No choroidal tubercles were demonstrable on fundus examination. Erythrocyte Sedimentation Rate (ESR) was elevated; 50mm/hour (Westergren method) and the Tuberculin test yielded an induration of 20 x 20 mm. Rest of the biochemical and hematological investigations were normal. Serology for Human Immunodeficiency Virus (HIV) was negative.

The chest radiograph (Figure 1) showed discrete, fine nodular densities implying miliary nodules diffusely in bilateral lungs, with consolidation and cavitation in left upper lobe in conjunction with mediastinal widening. Computed Tomography scan (CT) of thorax, axial section, showed consolidation with breakdown in left upper lobe, right paratracheal and prevascular lymphadenopathy (Figure 2a). High resolution images of lung window at the same level showed miliary nodules in bilateral upper lobes (Figure 2b). The sputum examination revealed typical Mycobacterium tuberculosis. Patient was started on anti-tubercular 4-drug combination therapy. Patient started showing signs of improvement, with the fever subsiding within two weeks of treatment.